As is well known the human knee comprises an articulation of the femur, the tibia and the patella. The femur and the tibia are maintained in a condition of stable articulation by a number of ligaments of which the principal ones are the anterior and posterior cruciate ligaments and the collateral ligaments. The rupture of the anterior cruciate ligament is relatively commonly encountered as a result of sporting injury or the like. This rupture leads to knee instability and can be a debilitating injury. Though less common the rupture of the posterior cruciate ligament can be equally disabling.
There have been a number of procedures designed to reconstruct the anterior cruciate ligament. Initially, attempts were made to replace the anterior cruciate ligament with tendons harvested from elsewhere in the body. These tendons were connected respectively to the femur and the tibia by staples, screws or the like inserted exteriorly into the bone and forming an external attachment to which the tendon could be connected externally of the bone. In some cases, the tendon passed over the top of one of the femoral condyles before attachment to the femur and in other cases a hole was drilled through the femur from outside the bone into the intercondylar notch. These attempts at cruciate ligament reconstruction had mixed success. The tendon tended to break at its point of connection to the bone, or become loose over time, indicating that the tendon bone interface was crucial for effective cruciate ligament reconstruction.
These problems led to the use of bone-tendon-bone grafts generally harvested from mid-third patella tendon with a bone block at each end. Each bone block is inserted into an appropriate hole drilled in the femur or the tibia and secured in place by a screw driven between the wall of the hole and the bone block. While this system has been very successful in many respects a significant number of patients continue to have patella-femoral problems, especially over the mid-third patella tendon donor site.
In an effort to overcome these problems it has been proposed to suture hamstring tendon to a bone block derived from coring the tibial tunnel and to thereby manufacture a bone/tendon/bone graft similar to a mid-third patella tendon graft. The present inventors have found that the bone quality is extremely variable. This results in poor fixation and poor intra-operative pull-out strength in some cases. This procedure was also found to be a very demanding surgical procedure, and therefore difficult to reproduce.
It is also known to provide a method for the reconstruction of the anterior cruciate ligament of a patient which comprises the steps of: PA1 a) forming a tendon graft from tendon, other soft tissue or artificial tendon; PA1 b) forming a hole through the patient's femur from a suitable point in the intercondylar notch therein anteriorly and laterally, the cross-sectional area of at least an end portion of the hole through the femur adjacent the intercondylar notch being sufficient to receive an end of the tendon graft and a suitable screw, peg or other fixation device having a leading end and a trailing end; PA1 c) forming a suitably positioned hole through the patient's tibia opening at one end adjacent the cross-sectional medial tibial spine of the tibia of an area sufficient to receive the other end of the tendon graft; PA1 d) drawing one end of the tendon graft into the enlarged end portion of the hole in the femur and simultaneously or sequentially drawing the other end of the tendon graft into the hole in the tibia; PA1 e) inserting the leading end of a fixation device into the hole in the femur from the intercondylar notch end thereof until the trailing end of the fixation device is at least adjacent that end of the hole, and the tendon graft is pressed directly and firmly against a sidewall of the hole in the femur by the fixation device; and PA1 f) after tensioning the tendon graft appropriately, securing the other end of the tendon graft to the tibia. PA1 a) forming a graft from tendon, other soft tissue or artificial tendon; PA1 b) forming a hole through the patient's femur opening at one end at a suitable point in the intercondylar notch in the femur; PA1 c) forming a suitably positioned hole through the patient's tibia opening at one end adjacent the cross-sectional medial tibial spine of the tibia; PA1 d) connecting one end of the graft to the elongate shaft of a connection device, which device comprises an elongate shaft and a cross member pivotally connected intermediate its ends to one end of the elongate shaft; PA1 e) passing the connection device into the hole in the femur from the intercondylar notch end thereof with the cross member lying alongside the elongate member until the cross member extends completely from the other end of the hole in the femur; PA1 f) rotating the cross member so that it lies transversely to the elongate member and pulling the connection device back so that the cross member lies against the surface of the femur; PA1 g) simultaneously or sequentially drawing the other end of the graft at least into the hole in the tibia; and PA1 h) after tensioning the graft appropriately, securing the other end of the tendon graft to the tibia.
The foregoing method is a significant improvement over the preceding methods however it still suffers from the theoretical and practical problems of placing a screw or like fastener into a blind hole between the graft and the bone surrounding the hole. The present invention provides the public with an alternative that does not necessarily require the placement of a screw into the hole carrying the graft through either the tibia or the femur.